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‘A powder keg waiting to go off’

A man collapses while being brought into the emergency department by police and paramedics. The department’s staff must work closely with outside emergency services and their own security staff in such cases.

Photograph by: Jason Payne
, PROVINCE

The drunk middle-aged man has been lying quietly on a gurney just inside the entrance to St. Paul’s emergency department. Brought in by paramedics, he appears to be asleep, his wrists shackled to the gurney’s rails. But after he’s wheeled into a Plexiglas-fronted room for treatment and unshackled, he comes unglued. Screaming profanities, he pounds his fists on the Plexiglas, spattering it with saliva as he directs abuse toward nearby nurses and doctors.

It’s Code White: time for hospital security to move. Seconds later, the man is returned to his gurney by three burly security guards and reshackled.

Unlike security guards who patrol buildings and shops, the emergency department’s protectors work closely with people. And because some of these people are both medically vulnerable and potentially violent, the guards must operate in close co-ordination with doctors and nurses.

“Here, it’s an integrated approach,” says Paladin Security director Chad Kalyk. “It’s not just a security function. You’re part of a patient-support team.”

“Any emergency [department] is really like a powder keg waiting to go off,” Brown says. “It’s so unpredictable. We strip people out of their clothes and we put them in a bed: we dehumanize people, and you have the potential for people to fight back.”

Add the mental illness and drug and alcohol abuse rampant in the Downtown Eastside, and “you’ve got more potential for violence,” Brown says.

But because the guards are so busy, medical staff may have to wait for an hour or more when they need security to escort them while attending to a volatile patient, says Dr. Anna Nazif, medical director of emergency psychiatry at St. Paul’s.

“All of the staff here say if we had more security guards our job would be a lot easier and safer,” Nazif says.

Although Paladin provides a spectrum of security services to customers, the guards who work at St. Paul’s emergency enjoy the challenge of working in a difficult environment, Kalyk says.

“They want to be down here,” Kalyk says. “They like it down here.”

Also part of the patient-support team are the paramedics who bring patients to St. Paul’s’ doors by ambulance.

“We talk to the triage nurse. We tell them what the patient’s chief complaint is and the surroundings we might have found them in and what procedures we might have taken,” says Elaine Campbell, a B.C. Ambulance Service paramedic for 17 years. If a patient is severely ill or grievously injured, the paramedics will call ahead to the emergency department so doctors and nurses can prepare.

“They’re able to set things up at their end and have their whole medical staff paged out and told to respond to the trauma room,” Campbell says.

Such a scenario would have occurred after paramedic Liz Tkatchenko and her partner responded to an overdose, but the incident occurred so close to St. Paul’s that there was no time to call ahead.

“The triage nurses had definitely been taken by a bit of a surprise when we rolled in with an unconscious male on our stretcher whose airway needed close monitoring,” Tkatchenko says. “After a brief moment of confusion, and a condensed report through the doorway, everything started to move at a quick pace. A doctor came out into the hallway to get a story from [us] so that he could generate the initial orders. As soon as the patient was taken to the trauma bay, everyone was ready to go.

“We had also warned the triage that there is another patient coming in from the same location, who, unlike the current one, was very agitated and combative. The bed was prepared, more nurses paged, and security put on standby. This made the second handover even smoother. Even when the environment in the department becomes very demanding, St. Paul’s ER staff can really pull it together.”

Paramedics often accompany doctors and nurses who are evaluating patients who have arrived by ambulance, to provide information about the patient’s problems and treatments administered before getting to hospital. With serious cases in one of the department’s two trauma bays, “we wait till the whole team is there and we tell our story,” Campbell says.

As first responders, paramedics witness horrendous suffering and gruesome injuries.

“We all have a hundred horror stories to tell that we’ve been part of,” Campbell says. “I don’t think there’s any amount of training that can prepare you for all the tragedy that you see.

“Most of us got into this job to get to help people and not really thinking about all the crappy things that you might see over the years.

Earlier in her career, Campbell would wake up at night with hot sweats related to seeing traumatic events, but she’s grown accustomed to such scenes.

“Unfortunately, you get used to it and you sort of just move on to the next call,” she says.

However, the trauma has a cumulative effect, Campbell says.

“You just need to step back and take a break, and do something other than paramedic stuff, medical stuff — find an outside activity,” she says. “I have a puppy, and I take her on long walks and down to the beach and on trails. I do a lot of renos around the house. And I have a motorcycle. Those are the things that I like to do, to keep my mind off things and have an outside life.”

A man collapses while being brought into the emergency department by police and paramedics. The department’s staff must work closely with outside emergency services and their own security staff in such cases.

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